不同评分系统对急性非静脉曲张性上消化道出血患者危险分层的预测价值

发布时间：2018-05-25 19:57

  本文选题：胃肠出血 + 急性非静脉曲张性上消化道出血　； 参考：《中国全科医学》2017年14期

【摘要】：背景成年人急性非静脉曲张性上消化道出血(ANVUGIB)是常见的临床急症,起病急、病情变化快,严重者可危及生命。如何迅速、准确地评估病情,快速分诊,制定合理的治疗方案是高效应用现有医疗资源,改善ANVUGIB患者预后的关键。目的探讨Glasgow-Blatchford评分(GBS)、AIMS65、Rockall评分系统对ANVUGIB患者危险分层评估的准确性和预测价值。方法选取2013—2015年天津医科大学总医院急诊科收治并确诊为ANVUGIB的246例患者,收集患者基本信息,并采用GBS、AIMS65、Rockall评分系统对患者进行危险分层。评估3种评分系统预测ANVUGIB患者干预、再出血、死亡的灵敏度、特异度、阳性预测值、阴性预测值及受试者工作特征(ROC)曲线下面积(AUC)。结果 246例患者中干预95例(38.6%),再出血15例(6.1%),死亡4例(1.6%)。GBS2分时,0例需干预、再出血和死亡;AIMS65评分2分时,19例需干预,1例再出血,1例死亡;Rockall评分2分时,6例需干预,1例再出血,0例死亡。当GBS、AIMS65、Rockall评分≤2分时,预测ANVUGIB患者需干预的灵敏度和特异度分别为100.0%、80.0%、93.7%和26.5%、45.7%、15.9%,阳性预测值和阴性预测值分别为46.1%、48.1%、41.2%和100.0%、78.4%、80.0%,AUC分别为0.675[95%CI(0.580,0.679)]、0.643[95%CI(0.545,0.741)]、0.653[95%CI(0.553,0.752)];预测再出血的灵敏度和特异度分别为100.0%、93.3%、93.3%和17.3%、37.7%、12.6%,阳性预测值和阴性预测值分别为7.3%、8.9%、6.5%和100.0%、98.9%、96.7%,AUC分别为0.809[95%CI(0.638,0.941)]、0.720[95%CI(0.643,0.873)]、0.800[95%CI(0.597,0.907)];预测死亡的灵敏度和特异度分别为100.0%、100.0%、75.0%和16.5%、36.0%、12.4%,阳性预测值和阴性预测值分别为1.9%、1.9%、1.8%和100.0%、98.9%、100.0%,AUC分别为0.848[95%CI(0.707,0.930)]、0.804[95%CI(0.723,0.976)]、0.838[95%CI(0.597,0.968)]。结论 GBS更适合急诊,GBS≤2分时,可被视为低风险患者,低风险患者可以接受门诊治疗,缓解住院压力和减少医疗资源浪费。
[Abstract]:Background Acute non-varicose upper gastrointestinal hemorrhage (ANVUGIBB) is a common clinical emergency in adults. How to evaluate the disease quickly and accurately, how to quickly divide the patients, and how to make a reasonable treatment plan are the key to use the existing medical resources efficiently and improve the prognosis of patients with ANVUGIB. Objective to evaluate the accuracy and predictive value of Glasgow-Blatchford scoring system in assessing risk stratification in patients with ANVUGIB. Methods two hundred and forty-six patients with ANVUGIB were selected from the emergency department of Tianjin Medical University General Hospital from 2013 to 2015. The basic information of the patients was collected and the risk stratification was carried out by using GBSU AIMS65 Rockall scoring system. The sensitivity, specificity, positive predictive value, negative predictive value and area under the operating characteristics curve of ANVUGIB patients were evaluated for predicting the intervention, rebleeding, mortality, specificity, positive predictive value, negative predictive value and area under the operating characteristics curve of the patients with ANVUGIB. Results among 246 patients, 95 cases were treated with intervention (38.6%), 15 cases with rebleeding (6. 1%), 4 cases with death (1. 6%). GBS2 (0 cases) needed intervention. 19 cases need to intervene in 1 case of rebleeding and 1 case of death Rockall score of 2 minutes. 6 cases need to intervene in 1 case and 1 case of bleeding again. 0 case died. When GBSU AIMS65 Rockall score 鈮，

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